Stephen Barrett, M.D.

In 2007, the Texas Medical Board charged that the actions of Alfred Johnson, D.O., related to the diagnosis, treatment, and billing of a patient were
below the standard of care. The complaint (shown below) states that Johnson
diagnosed the patient with an "allergy" to diesel and car exhaust fumes
and injected extracts of these substances to allegedly "desensitize" the
patient. Calling the treatment "nonsensical," the complaint also states:

Johnson's based his diagnosis on improper tests
and failed to consider common causes of the patient's symptoms.

Johnson's patient consent procedure does not inform
patients that his approach is unproven.

Johnson's billing was false and
fraudulent because there is no generally accepted medical or scientific
basis for his actions.

In 2010, Johnson signed a mediated stipulated order under which he was reprimanded, fined $4,500, and ordered to take 32 hours of continuing medical education courses related to allergy and immunology. He must also use a stipulated consent agreement and segregate records to provide ready access to relevant charts in the event of a future related investigation by the Medical Board.

Johnson was also licensed in Missouri and Florida. In 2010, he and the Missouri State Board of Registration for the Healing Arts signed a settlement agreement under which he was reprimanded, ordered to provide a list of the extracts that he used in his practice, and required to comply with the Texas Medical Board's order. In 2013, he entered into a settlement agreement with the Florida Board of Osteopathic Medicine under which he was reprimanded, fined $2,500, ordered to pay $764.12 for costs, and requiured to show proof of completing 18 hours of continuing education in allergy and immunology as required by the Texas Medical Board. The Florida Department of HealthWeb site indicated that Johnson's license expired in 2010.

Johnson operates Johnson Medical
Associates in Richardson, Texas. His Web site says that he has a special interest in "allergy
and environmental medicine" and is a fellow, former board member,
and course director of the American Academy of Environmental Medicine. This
group promotes the offbeat theories and practices associated with
"multiple chemical sensitivity (MCS)," a diagnosis not recognized
by the scientific community. Quackwatch
has a detailed discussion of "MCS."

COMPLAINT

TO THE HONORABLE TEXAS MEDICAL BOARD AND THE HONORABLE ADMINISTRATIVE LAW
JUDGE TO BE ASSIGNED:

COMES NOW, the Staff of the Texas Medical Board (the "Board"), and
files this Complaint against Alfred Raymond Johnson, D.O., ("Respondent"),
based on Respondent's alleged violations of the Medical Practice Act (''the
Act"), Title 3, Subtitle B, Texas Occupations Code, and would show the
following:

I. INTRODUCTION

The filing of this Complaint and the relief requested are necessary to protect
the health and public interest of the citizens of the State of Texas, as provided
in Section 151.003 of the Act.

II. LEGAL AUTHORITY AND JURISDICTION

Respondent is a Texas physician and holds Texas Medical License No. F-8525,
issued by the Board on December 3, 1980, which was in full force and effect
at all times material and relevant to this Complaint. All jurisdictional requirements
have been satisfied. Respondent received notice of the Informal Settlement
Conference (ISC) and appeared at the ISC. All procedural rules were complied
with, including but not limited to, Board Rules 182 and 187, as applicable.

III. PROCEDURAL BACKGROUND

1. The Board received· information that Respondent may have violated
the Act and, based on that information, conducted an investigation. The investigation
compiled evidence that supported allegations of a violation.

2. Respondent was invited to attend an Informal Show Compliance Proceeding
and Settlement Conference ("ISC"), held on May 22, 2007, which was
conducted in accordance with §2001.054(c), TEX. GOV'T CODE and §164.004
of the Act. The Board representatives, ("Panel"), including one physician
and one public member, reviewed and considered evidence from the investigation,
as well as any information presented by Respondent. The Panel determined that
Respondent had not shown compliance with. all requirements· of the Act.
The Panel offered an Agreed Order. Respondent did not accept the proposed Agreed.
Order and this matter has not settled.

IV. FACTUAL ALLEGATIONS

Board Staff has received information and based on that information believes
that Respondent has violated the Act. Based on such information and belief,
Board Staff alleges:

Respondent has violated the standard of care related to a single patient,
R.L. Respondent treated R.L. for sensitivity/toxic exposure to benzene and
homologues. The treatment consisted of injections of diesel fuel and car exhaust
fumes extract to allegedly de-sensitize R.L. to the materials. Respondent's
action related to the diagnosis, treatment and billing of R.L. is below the
standard of care for the following reasons:

Respondent failed to perform an appropriate assessment of R.L.'s complaints.
The inadequate assessment includes the failure to rule in/rule out common causes/etiologies
for R.L.'s presenting symptoms. Respondent's medical decision-making lacks
any proven medical basis.

The Respondent's use of allergy testing for ''benzene, homologues, diesel
and car fume exhaust" sensitivity is below the standard of care. There
is no scientific basis for using skin testing to establish a diagnosis of an "allergy" to
these products. These products are chemical irritants and are a known to cause
an irritation reaction to the skin. Any "positive" result is meaningless
because the reactions caused are not allergic reactions and they cannot be
treated by de-sensitization.

Respondent demonstrates a substandard knowledge of basic immunology. Respondent's
use and interpretation of tests and diagnostic conclusions demonstrate an
obvious lack of understanding of basic immunology.

Respondent misled patients, including R.L., into believing they have either
an autoimmune or immunologic basis for their complaints.

Respondent's treatments for R.L. were inappropriate; not based on any evidence;
not· based on any physiologic correlation; and nonsensical. The treatment
can be harmful. Injections of diesel fuel and car exhaust fume are a dangerous
practice, are medically unsupported, and are unreasonable. These types of
injections lack any generally accepted scientific basis.

Respondent's treatment of R.L. not generally accepted in the scientific
or medical community. When making a medical diagnosis or to reach medically
unreasonable conclusions regarding a diagnosis by relying on unproven "science," testing
and treatment that is not recognized or generally accepted in the medical
and scientific community is below the standard of care.

There is no scientific support, peer-reviewed studies, or generally accepted
medical studies, literature or testing that has demonstrated that the use
of diesel fuel and car exhaust fume extract creates a de-sensitization to
benzene and homologues.

The testing and treatment utilized by Respondent do not qualify as experimental,
complementary, or alternative medicine. There are no reputable studies from
peer review journals that confirm the use of diesel fuel or car fume exhaust
extract as a treatment in a clinical practice.

The Patient consent utilized by Respondent does not inform the patients
regarding the unproven nature of the therapies and testing recommended.

Respondent's determinations and/or diagnosis are not supported by peer-reviewed
studies or established science. Respondent's medical decision-making, including
treatment with diesel fuel and/or car exhaust fumes extract, is based on
theories, opinions and analysis that have not been sufficiently tested. His
diagnosis and treatment is not generally accepted in the medical community,
and is not supported by established scientific evidence.

Respondent's billing for these office visits, testing, and treatment is
false and fraudulent because there is no generally accepted medical or scientific
basis for his actions.

V. APPLICABLE STATUTES, RULES, AND AGENCY POLICY

Respondent's conduct, as described above, constitutes grounds for the Board
to revoke or suspend Respondent's Texas medical license or to impose any other
authorized means of discipline upon the Respondent. The following statutes,
rules, and agency policy are applicable to this matter:

A. Procedures for the Conduct of this Hearing:

Section 164.007(a) of the Act requires that the Board adopt procedures
governing formal disposition of a contested case before the State Office
of Administrative Hearings.

TEX. ADMIN. CODE, Chapter 187 sets forth the procedures adopted by the
Board under the requirement ofSection.164.007(a) of the Act.

TEX. ADMIN. CODE §155.3(c) provides that the procedural rules of the
state agency on behalf of which the hearing is conducted govern procedural
matters that relate to the hearing as required by law, to wit: Section 164.007(a)
of the Act, as cited above.

Respondent is subject to disciplinary action pursuant to Section 164.051(a)(1)
of the Act based on Respondent's commission of an act prohibited under Section
164.052 of the Act.

Section 164.051(a)(3) of the Act authorizes the Board to take disciplinary
action against Respondent based on Respondent's violation of a Board Rule:
to wit, Board Rule 165, requiring a physician to maintain adequate medical
records; and Board Rule 200, related to the requirements for practicing Complementary
and Alternative Medicine.

Section 164.051(a)(6) of the Act authorizes the Board to take disciplinary
action against Respondent based on Respondent's failure to practice medicine
in an acceptable professional manner consistent with public health and welfare.,Board
Rule § 190.8(A), (B), (D), and (I) define failure to practice medicine
in an acceptable professional manner as, but not limited to: failure to treat
a patient according to the generally accepted standard of care; negligence
in performing medical services; failure to safeguard against potential complications;
and failure to obtain informed consent from the patient or other person authorized
by law to consent to treatment on the patient's behalf before performing
tests, treatments or procedures.

Section 164.052(a)(5) and 164.053 of the Act authorizes the Board to take
disciplinary action against Respondent based upon Respondent's unprofessional
or dishonorable conduct that is likely to deceive or defraud the public or
injure the public. Board Rule § 190.8(2)(J) defines unprofessional or
dishonorable conduct as, but not limited to, providing medically unnecessary
services to a patient.

Sections 164.052(a)(5) and 164.053(a)(5) of the Act authorizes the Board
to take disciplinary action against Respondent based on Respondent prescribing
or administering a drug or treatment that is nontherapeutic in nature or
nontherapeutic in the manner the drug or treatment is administered or prescribed.

Respondent has committed a prohibited act or practice within the meaning
of Chapter 105.002(a)(2) of the Tex. Occ. Code by Respondent's knowingly
preparing, making, or subscribing to any writing, with the intent to present
or use the writing, or to allow it to be prepared or used in support of a
false or fraudulent claim under an insurance policy.

Respondent has committed· a prohibited act or practice within the
meaning of Section 3.08(4)(G) of TEX. REV. CIV. STAT. ANN. art. 4495(b) by
violating section 311.0025 of the Texas Health and Safety Code, which provides
that a .. health care professional may not submit to a patient or a third
party payer a bill for a treatment that professional knows was not provided
or knows was improper, unreasonable, or medically or clinically unnecessary.

Respondent has committed a prohibited act or practice within the meaning
of Sections 164.052(a)(5) and 164.053(a)(7) of the Act by violating Section
311.0025 of the Texas Health & Safety Code, which provides that a health
care professional may not submit to a patient or a third party pay or a bill
for a treatment that professional knows was not provided or knows was improper,
unreasonable, or medically or clinically unnecessary.

Respondent has committed a prohibited act or practice, and is subject to
discipline pursuant to Sections 101.203 of the Act, which provides that a
health care professional may not violate Section 311.0025 of the Health· and
Safety Code.

C. Sanctions that May Be Imposed:

Section 164.001 of the Act authorizes the Board to impose a range of disciplinary
actions against a· person for violation of the Act or a Board rule.
Such sanctions include: revocation, suspension, probation, public reprimand,
limitation or restriction on practice, counseling or treatment, required
educational or counseling programs, monitored practice, public service, and
an administrative penalty.

Chapter 165, Subchapter A of the Act sets forth statutory requirements
for the amount and basis of an administrative penalty.

22 TEX. ADMIN. CODE Chapter 187.39 authorizes the Board to assess, in addition
to any penalty imposed, costs of the investigation and administrative hearing
in the case of a default judgment, or upon adjudication that Respondent is
in violation of the Act after a trial on the merits.

22 TEX. ADMIN. CODE Chapter 190 provides disciplinary guidelines intended
to provide guidance and a framework of analysis for administrative law judges
in the making of recommendations in contested licensure and disciplinary
matters and to provide guidance as to the types of conduct that constitute
violations of the Act or board rules.

22 TEX. ADMIN. CODE Chapter 190.15 provides the authority for this Board
to consider aggravating factors in this case. This practice demonstrates
a potential for patient harm, economic harm to the patients or entity, increased
potential to harm the public through this continuing pattern of practice,
attempted concealment of the conduct, the conduct was premeditated, intentional· conduct,
and was motivated for enrichment of Respondent with a disregard for patient
well-being, this pattern shows likelihood of similar future conduct, all
of which increase the potential harm and seriousness of the violations.

VI. NOTICE TO RESPONDENT

IF YOU DO NOT FILE A WRITTEN ANSWER TO THIS NOTICE WITH THE STATE OFFICE OF
ADMINISTRATIVE HEARINGS WITHIN 20 DAYS OF THE DATE NOTICE OF SERVICE WAS MAILED,
A DEFAULT JUDGMENT MAY BE ENTERED AGAINST YOU, WHICH MAY INCLUDE THE DENIAL
OF LICENSURE OR ANY OR ALL OF THE REQUESTED SANCTIONS INCLUDING THE REVOCATION
OF YOUR LICENSE. IF YOU FILE A WRITTEN ANSWER, BUT THEN FAIL TO ATTEND THE
HEARING, A DEFAULT JUDGMENT MAY BE ENTERED AGAINST YOU, WHICH MAY INCLUDE THE
DENIAL OF LICENSURE OR ANY OR ALL OF THE REQUESTED SANCTIONS INCLUDING THE
REVOCATION OF YOUR LICENSE. A COPY OF ANY RESPONSE YOU FILE WITH THE STATE
OFFICE OF ADMINISTRATIVE HEARINGS SHALL ALSO BE PROVIDED TO THE HEARINGS COORDINATOR
OF THE TEXAS MEDICAL BOARD.

WHEREFORE, PREMISES CONSIDERED, Board Staff requests that an administrative
law judge employed by the State Office of Administrative Hearings conduct a
contested case hearing on the merits of the Complaint, in accordance with Section
164.007(a) of the Act. Upon final hearing, Board Staff requests that the Honorable
Administrative Law Judge issue a Proposal for Decision ("PFD") that
reflects Respondent's violation of the Act as set forth in this Complaint.
Following issuance of the PFD, Board Staff requests that the Board, pursuant
to §164.001 and §165.003 of the Act and Board Rules 187.30, 187.39,
190.8, 190.14, 190.15 and 190.16, enter an Order imposing any and all sanctions
or disciplinary measures necessary to protect health and public welfare, including
the imposition on Respondent of SOAR hearing costs and an administrative penalty.